What Is Cranioplasty?

In open brain injury, especially after firearm injury, due to the need for debridement, skull defects of different scopes are often left after surgery. In closed wounds, decompression of the bone flap is often necessary due to severe swelling of the brain.

Cranioplasty

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In open brain injury, especially after firearm injury, due to the need for debridement, skull defects of different scopes are often left after surgery. In closed wounds, decompression of the bone flap is often necessary due to severe swelling of the brain.

Chinese name

Cranioplasty

Alias

Cranioplasty

Cranioplasty

Cranioplasty

Neurosurgery / Craniocerebral injury surgery / Craniocerebral closure injury

02.0

In open brain injury, especially after firearm injury, due to the need for debridement, skull defects of different scopes are often left after surgery. In closed wounds, decompression of the bone flap is often necessary due to severe swelling of the brain. Large skull defects remained after the operation. Bone defects less than 3cm in diameter often do not cause discomfort, and generally do not need plastic surgery, and those with a diameter of 3cm or more are suitable for cranioplasty. The purpose of cranioplasty: Avoid re-injury of the brain. Treatment of skull defect syndrome. For plastic surgery. In the repair materials, the autogenous ribs, sacrums or allogeneic bones have been used in the past, and now they are rarely used. Currently more commonly used are titanium alloy plates and plexiglass. Some skulls removed during the operation are temporarily buried under the skin and remain in the patient's body. They will be removed and placed in the skull defect area during the operation. Some people also use high-molecular fiber reinforced materials, whose toughness, hardness, and bendability are suitable for the skull. And has good biocompatibility, stable chemical properties, non-toxic, no antigen-antibody reaction. After the repair, there is no burning sensation in the local area, which does not cause radiation-induced chronic brain damage, and has the advantages of light weight, easy cutting and shaping. Except that the old depression fracture is a one-stage operation, the plastic surgery should be performed 3 to 6 months after the first operation. Patients with traumatic infection need to be administered after one year of wound healing.

Cranoplasty is suitable for:

1. The diameter of bone defect is more than 3cm, which affects the protection of the brain.

2. Have severe subjective symptoms. Such as dizziness, headache, symptoms increased when the head position changes.

3. There are serious mental burdens, such as fear of sound, vibration, and trauma.

4. Large-scale bone defects that hinder appearance.

5. Epilepsy in the defect area.

1. There is an infection in the wound, or the infection has healed but less than 1 year.

2. There are still people with increased intracranial pressure.

3. Debridement was not thorough enough, and fragments of bone remained.

4. People with severe neurological dysfunction or mental disorders.

In addition to conventional craniotomy preparations, a drill hole should be made every 2 cm when preparing the graft to make adhesion between the scalp and the meninges in the future, which will help to fix the graft.

More local anesthesia is used, and general anesthesia can also be used. Take the corresponding position according to the defect site.

1. Make a horseshoe incision along the edge of the defect. The flap's blood supply should be fully considered when designing the flap.

2. Separate from the cap-shaped aponeurosis, and use an automatic retractor to retract the incision after flipping the flap.

3. On the edge of the bone defect, peel off the dura mater to reveal the edge of the bone defect.

4. Use the bite forceps to trim the irregular bone defect edge. Make the bone margins neat and sloped, so that the shaped implants will not sag after implantation.

5. Place the sterilized prepared implant on the defect, and trim the implant according to the size and shape of the defect, so that the shape of the implant is suitable for the convexity of the skull, and it is very stable and difficult to move after placing on the defect.

6. Fixation of the implant Make the implant and the skull fixed at 4 points. Use a Kirschner wire to drill the hole in the skull. Do not drill the hole close to the edge of the bone. Use a thick wire or stainless steel wire. If the skull defect is large, the dura mater should be suspended and fixed on the graft with silk thread to reduce dead space and prevent postoperative hematoma and effusion.

7. Finally suture the scalp. Drain under the scalp.

1. When free skin flap peels off the scar of the original incision, it must be biased to the inside, and a flap of a certain thickness must be retained to prevent the scalp from being stripped too thin and the blood supply insufficient to cause scalp necrosis.

2. Proper resection of the meninges and pathological tissues of the brain will help prevent postoperative epilepsy and repair the dura mater to prevent cerebrospinal fluid leakage.

3. If the wire is used to fix the graft, the broken end of the wire should be folded into the bone hole to avoid irritating the scalp and causing pain after surgery.

Pay attention to the swelling of the incision and floating of the graft. If there are symptoms of cerebral compression, it is suggested that there is intracranial hematoma or effusion. The hematoma should be removed by surgery. The effusion can be treated with puncture and aspiration.

1. The post-implant effusion can often heal by suction after suction.

2. Epidural hematoma has many new capillaries in the scar due to adhesions. Extensive bleeding of the wound is easy to occur after separation. Before suture the incision, hemostasis should be completely stopped.